Consideraciones anestésicas para cesárea electiva en una paciente con quiste de Tarlov gigante / Anaesthetic considerations for elective cesarean section in a patient with a giant Tarlov cyst

Los quistes de Tarlov son una dilatación patológica de las meninges. Su incidencia es más frecuente en mujeres de edades comprendidas entre 30 y 50 años. La prueba de imagen de elección para su diagnóstico es la RM. De etiología desconocida, la mayoría de los casos son asintomáticos, pero pueden manifestarse síntomas de irritación radicular, entre otros. Las posibilidades terapéuticas son múltiples, reservando la escisión quirúrgica como último escalón. Presentamos un caso en el que se realiza con éxito una anestesia raquídea para una cesárea electiva en una paciente con un quiste de Tarlov gigante, pero con potencial compromiso de la vía aérea, en la que la que los riesgos de una anestesia general podrían estar aumentados. El manejo anestésico presenta un desafío para el anestesiólogo, especialmente en situaciones en las que el paciente presente un riesgo anestésico aumentado para la anestesia general, como es el caso de la paciente obstétrica.(AU)

Tarlov cysts are a pathological dilatation of the meninges. Their incidence is more frequent in women between 30 and 50 years of age. The imaging test of choice for diagnosis is MRI. Of unknown etiology, most cases are asymptomatic, but symptoms of radicular irritation, among others, may occur. The therapeutic possibilities are multiple, reserving surgical excision as the last option. We report a case of successful spinal anaesthesia for elective cesarean section in a patient with a giant Tarlov cyst but with potential airway compromise, in whom the risks of general anaesthesia would be increased. Anaesthetic management presents a challenge for the anesthesiologist, especially in situations where the patient presents an increased anaesthetic risk for general anaesthesia, as is the case in the obstetric patient.(AU)

Anaesthetic considerations for elective cesarean section in a patient with a giant Tarlov cyst.

Tarlov cysts are a pathological dilatation of the meninges. Their incidence is more frequent in women between 30 and 50 years of age. The imaging test of choice for diagnosis is MRI. Of unknown etiology, most cases are asymptomatic, but symptoms of radicular irritation, among others, may occur. The therapeutic possibilities are multiple, reserving surgical excision as the last option. We report a case of successful spinal anaesthesia for elective cesarean section in a patient with a giant Tarlov cyst but with potential airway compromise, in whom the risks of general anaesthesia would be increased. Anaesthetic management presents a challenge for the anesthesiologist, especially in situations where the patient presents an increased anaesthetic risk for general anaesthesia, as is the case in the obstetric patient.

Biofilms en instalaciones alimentarias militares. Comparación de técnicas rápidas de vigilancia y verificación / Biofilms in military food facilities. Comparison of rapid surveillance and verification techniques

Introducción:Los patógenos formadores de biofilms incrementan el riesgo de contaminación biológica de los alimentos en las industrias alimentarias, por lo que es necesario cuantificar y cualificar los peligros presentes en los mismos.Objetivo:Se pretende demostrar la presencia de biofilms bacterianos en las superficies de trabajo de instalaciones alimentarias militares (IAM) mediante distintas técnicas rápidas de control higiénico.Material y métodos:Se analizaron un total de 550 muestras entre las 10 IAM: Cada IAM contó con 5 puntos de muestreo (n = 50) y en cada uno de ellos se obtuvieron 11 muestras sobre una superficie de 100 cm2, para poner de manifiesto la presencia de biofilms y establecer la correlación entre las siguientes técnicas analíticas: determinación de adenosín trifosfato (ATP) mediante luminómetro 3M Clean-Trace™ NG3, valoración de residuos proteicos con hisopos Clean-Trace™ Surface Protein Plus, recuentos de microorganismos aerobios mesófilos (AC) mediante sistema TEMPO® y Petrifilm™, y visualización de biofilms mediante reacción enzimática con Biofinder®.Resultados:Se encontró correlación estadísticamente significativa (p < 0,05) entre las determinaciones de ATP y la presencia de biofilms y de residuos proteicos. También se halló linealidad con significación estadística (R2 0,422, p < 0,05) entre el ATP y el recuento de AC por TEMPO®. Se observó correlación y concordancia entre los recuentos de AC mediante el sistema TEMPO® y a través de Petrifilm™ (coeficiente de correlación intraclase 0,463, IC 95%: 0,179-0,673, p < 0,05). En ningún punto de muestreo (PM) se detectaron bacterias patógenas.Conclusión:Se detectaron biofilms en una tercera parte de los PM inspeccionados. Su monitorización combinando técnicas rápidas debe tenerse en consideración en los procedimientos de vigilancia del sistema de Análisis de Peligros y Puntos de Control Crítico (APPCC). (AU)

Introduction:Biofilm-forming pathogens increase the risk of biological food contamination in food industries, thus it is necessary to quantify and qualify the dangers present in them.Objective:To demonstrate the presence of bacterial biofilms on the work surfaces of military food facilities using different rapid hygienic control techniques.Materials and methods:An amount of 550 samples were analyzed among 10 military food facilities: Each one had 5 sampling points (n = 50) and in each of them 11 samples were obtainded on a surface of 100 cm2 to assess the presence of biofilms and to establish the correlation between different analytical techniques: determination of adenosin triphosphate (ATP) using 3M Clean-Trace ™ NG3 luminometer, protein residue titration with Clean-Trace ™ Surface Protein Plus swabs, mesophilic aerobic microorganism (AC) counts using TEMPO® and Petrifilm ™ system, and visualization of biofilms using enzymatic reaction with Biofinder®.Results:A statistically significant correlation (p <0.05) was found between ATP determinations and the presence of biofilms and protein residues. Linearity with statistical significance (R2 0.422, p <0.05) was also found between ATP and AC count by TEMPO®. Correlation and concordance between AC counts were observed using the TEMPO® system and through Petrifilm ™ (intraclass correlation coefficient 0.463, 95% CI: 0.179-0.673, p <0.05). At no sampling point (SP) were pathogenic bacteria detected.Conclusion:Combining quick techniques should be considered in surveillance procedures of Hazard Analysis and Critical Control Points (HACCP). (AU)

Cuantificación de gluten en las raciones de combate españolas / Quantification of gluten in Spanish combat rations

Las personas con enfermedad celiaca pueden ingresar en los centros docentes militares de formación y su alimentacióndurante los ejercicios de instrucción se puede realizar mediante raciones de combate, individuales o colectivas. Objetivo: Cuantificar elgluten en las raciones de combate con etiquetado precautorio de alérgenos (EPA) o sin gluten en su composición. Material y Métodos:Se analizaron 39 muestras de raciones individuales de combate (23 con EPA y 16 sin cereales con gluten en su composición) y 6 racionescolectivas (sin cereales con gluten en su composición), mediante un kit comercial de inmunoabsorción ligada a enzimas (ELISA). Resultados: Los resultados de todas las muestras se encontraron por debajo del límite de cuantificación (< 5mg/kg de gluten). Conclusiones:Los resultados del contenido en gluten obtenidos sobre las muestras y los lotes analizados muestran un riesgo bajo de exposición. (AU)

People with celiac disease can join the military training centers and and their diet during training exercises can be donethrough combat rations, individual or collective rations. Objective: To quantify the gluten in the combat rations with precautionarylabeling of allergens (PAL) or gluten-free in its composition. Material and Methods: 39 individual operational rations samples (23with PAL and 16 without cereals with gluten in their composition) and 6 collective rations (without cereals with gluten in their composition) were analyzed using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results: All samples were below thelimit of quantification (< 5mg/kg of gluten) and the results met the quality criteria. Conclusions: The gluten results obtained on thesamples and batches analyzed show a low risk of exposure. (AU)

Dietary intake of advanced glycation end products (AGEs) and changes in body weight in European adults.

PURPOSE: Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5 years of follow-up. METHODS: A total of 255,170 participants aged 25-70 years were recruited in ten European countries (1992-2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11 years later depending on the study center. A reference database for AGEs was used containing UPLC-MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects. RESULTS: A one-SD increment in CEL intake was associated with 0.111 kg (95% CI 0.087-0.135) additional weight gain over 5 years. The corresponding additional weight gain for CML and MG-H1 was 0.065 kg (0.041-0.089) and 0.034 kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish. CONCLUSION: In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5 years of follow-up.

Transitando hacia el ejercicio de autonomía y liderazgo:… «para el posicionamiento hay que luchar¼ / Moving towards the practice of autonomy and leadership:… «Positioning requires striving¼ / Transitar para o exercício de autonomia e liderança:… «Para o posicionamento, tem que lutar¼

Resumen Introducción: En Chile, las enfermeras/os tienen respaldo legal para gestionar el cuidado, esto facilita el desarrollo de competencias para ejercer autonomía y liderazgo. Actualmente persisten barreras para transitar hacia un reconocimiento real de la independencia profesional. Objetivo: Develar la experiencia vivida de enfermeras con cargos en niveles de jefatura respecto al propio desarrollo para lograr el liderazgo y autonomía profesional. Metodología: Estudio cualitativo, descriptivo-interpretativo, desde la trayectoria fenomenológica de Edmund Husserl. Muestreo selectivo de caso homogéneo de tres enfermeras que desempeñaban rol de jefatura en instituciones de salud, región Valparaíso, Chile. Participación consentida. Entrevista no estructurada. Análisis del discurso utilizando el modelo de liderazgo integral de Ken Wilber. Resultados: Categorías: Conciencia del líder «ser inquieta...intelectualmente¼. Construyendo competencias «el liderazgo se aprende¼. Transitando hacia el ejercicio de la autonomía y el liderazgo, "para el posicionamiento hay que luchar". El peso de las estructuras organizacionales «tu rol es parte de un hospital¼. Interpretación: El ejercicio del liderazgo y la autonomía se fundamenta en competencias actitudinales por sobre las cognitivas y técnicas. Existe mayor apoyo y reconocimiento a nivel institucional, que al interior del equipo de salud. Persisten limitaciones para lograr máxima expresión del liderazgo y autonomía, por persistencia de modelos institucionales hegemónicos, centrados en decisiones médicas y desconocimiento del rol integrado. Conclusión: El líder se mueve en un escenario dual, entre un menor reconocimiento del equipo y un creciente empoderamiento del rol autónomo y visibilidad a nivel directivo institucional.

Abstract Introduction: In Chile, nurses have legal support to manage care, a situation which facilitates the development of competencies to perform with autonomy and leadership; however, barriers still persist while moving towards a real acknowledgement of professional independency. Objective: To unveil the lived experience of nurses in executive roles regarding their own development towards leadership and professional autonomy. Methodology: This is a descriptive and interpretative qualitative study framed by the Edmund Husserl phenomenological approach. The sample by homogeneous case included three nurses in executive roles in health institutions in Valparaiso, Chile. The participation was by consent. An unstructured interview was used. For the discourse analysis, the Ken Wilber integral leadership model was followed. Results: Categories: Leadership awareness <being inquiring… intellectually>… Building Competencies <leadership is learned>. Moving towards the practice of autonomy and leadership, "positioning requires striving". Weight of the organizational structures <your role is part of a hospital>. Interpretation: A practice of leadership and autonomy is based on attitude competencies over the cognitive and technical ones. Nevertheless, there still persist limitations to achieve a maximal expression of leadership and autonomy due to hegemonic institutional models which focus on medical decisions and neglect the integrated roles. Conclusion: The leader moves in a dual setting between a lower acknowledgement from the team, and a higher empowerment of the autonomous role and the visibility at the institutional directive level.

Resumo Introdução: No Chile, as enfermeiras/os têm apoio legal para gerenciar o cuidado, isto facilita o desenvolvimento de competências para exercer autonomia e liderança. Atualmente, persistem barreiras para transitar em direção a um reconhecimento real da independência profissional. Objetivo: Desvendar a experiência vivida de enfermeiras com cargos em níveis de chefia ao respeito do próprio desenvolvimento, para atingir a liderança e autonomia profissional. Metodologia: Estudo qualitativo, descritivo-interpretativo, desde a trajetória fenomenológica de Edmund Husserl. Amostragem seletiva de caso homogéneo de três enfermeiras que desempenhavam papel de chefia em instituições de saúde, região Valparaíso, Chile. Participação consentida. Entrevista não estruturada. Análise de discurso, utilizou-se o modelo de liderança integral de Ken Wilber. Resultados: Categorias: Consciência do líder «ser irrequieta...intelectualmente¼. Ir construindo competências «a liderança se aprende¼. Transitar em direção ao exercício da autonomia e a liderança, "para o posicionamento tem que lutar". O peso das estruturas organizacionais «seu rolo é parte de um hospital¼. Interpretação: O Exercício da liderança e a autonomia fundamenta-se em competências atitudinais, sobre as cognitivas e técnicas. Existe maior apoio e reconhecimento a nível institucional, que no interior da equipe de saúde. Persistem limitações para atingir a máxima expressão de liderança e autonomia, por persistência de modelos institucionais hegemónicos, centrados em decisões médicas e desconhecimento do rolo integrado. Conclusão: O líder movimenta-se em um cenário dual, entre um menor reconhecimento da equipe e um empoderamento crescente do rolo autónomo e visibilidade a nível diretivo institucional.

Dose reconstruction from PET images in carbon ion therapy: a deconvolution approach.

Dose and range verification have become important tools to bring carbon ion therapy to a higher level of confidence in clinical applications. Positron emission tomography is among the most commonly used approaches for this purpose and relies on the creation of positron emitting nuclei in nuclear interactions of the primary ions with tissue. Predictions of these positron emitter distributions are usually obtained from time-consuming Monte Carlo simulations or measurements from previous treatment fractions, and their comparison to the current, measured image allows for treatment verification. Still, a direct comparison of planned and delivered dose would be highly desirable, since the dose is the quantity of interest in radiation therapy and its confirmation improves quality assurance in carbon ion therapy. In this work, we present a deconvolution approach to predict dose distributions from PET images in carbon ion therapy. Under the assumption that the one-dimensional PET distribution is described by a convolution of the depth dose distribution and a filter kernel, an evolutionary algorithm is introduced to perform the reverse step and predict the depth dose distribution from a measured PET distribution. Filter kernels are obtained from either a library or are created for any given situation on-the-fly, using predictions of the [Formula: see text]-decay and depth dose distributions, and the very same evolutionary algorithm. The applicability of this approach is demonstrated for monoenergetic and polyenergetic carbon ion irradiation of homogeneous and heterogeneous solid phantoms as well as a patient computed tomography image, using Monte Carlo simulated distributions and measured in-beam PET data. Carbon ion ranges are predicted within less than 0.5 mm and 1 mm deviation for simulated and measured distributions, respectively.

Acceptability of self-sampling and human papillomavirus testing among non-attenders of cervical cancer screening programs in El Salvador.

In a cross-sectional study carried out in El Salvador between February 2016 and July 2017, self-sampling and human papillomavirus (HPV) testing was found to be highly acceptable among 2019 women who had not attended a cervical cancer screening in at least 3 years. Within this population, HPV positivity rates differed according to age, marital status, number of children, and lifetime sexual partners. The proportion of women who tested HPV positive or who were diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) was similar to the general population of the area. Among the reasons for failing to participate in previous screening programs, non-attending women described logistic concerns, but also erroneous beliefs regarding HPV and cervical cancer, misconceptions regarding the screening procedure, discomfort with male providers, and confidentiality fears. The aim of this study was to identify opportunities and challenges that emerged from the use of self-sampling and HPV testing as part of a public cervical cancer control effort in a low-resource setting.

Emergence of a Higher Energy Structure in Strong Field Ionization with Inhomogeneous Electric Fields.

Studies of strong field ionization have historically relied on the strong field approximation, which neglects all spatial dependence in the forces experienced by the electron after ionization. More recently, the small spatial inhomogeneity introduced by the long-range Coulomb potential has been linked to a number of important features in the photoelectron spectrum, such as Coulomb asymmetry, Coulomb focusing, and the low energy structure. Here, we demonstrate using midinfrared laser wavelength that a time-varying spatial dependence in the laser electric field, such as that produced in the vicinity of a nanostructure, creates a prominent higher energy peak. This higher energy structure (HES) originates from direct electrons ionized near the peak of a single half-cycle of the laser pulse. The HES is separated from all other ionization events, with its location and width highly dependent on the strength of spatial inhomogeneity. Hence, the HES can be used as a sensitive tool for near-field characterization in the "intermediate regime," where the electron's quiver amplitude is comparable to the field decay length. Moreover, the large accumulation of electrons with tuneable energy suggests a promising method for creating a localized source of electron pulses of attosecond duration using tabletop laser technology.

Phase matching effects in high harmonic generation at the nanometer scale.

Plasmon resonances are known to amplify the electromagnetic fields near metallic nanostructures, providing a promising scheme to generate extreme-ultraviolet harmonics using low power drivings. During high-order harmonic generation (HHG), the driving and harmonic fields accumulate a phase difference as they propagate through the target. In a typical set-up -a laser focused into a gas jet- the propagation distances amount to several wavelengths, and the cumulative phase-mismatch affects strongly the efficiency and properties of the harmonic emission. In contrast, HHG in metallic nanostructures is considered to overcome these limitations, as the common sources of phase mismatch -optical density and focusing geometry- are negligible for subwavelength propagation distances. We demonstrate that phase matching still plays a relevant role in HHG from nanostructures due to the non-perturbative character of HHG, that links the harmonic phase to the intensity distribution of the driving field. Our computations show that widely used applications of phase matching control, such as quantum path selection and the increase of contrast in attosecond pulse generation, are also feasible at the nanoscale.

Spin-valley dynamics of electrically driven ambipolar carbon-nanotube quantum dots.

An ambipolar n-p double quantum dot defined by potential variation along a semiconducting carbon-nanotube is considered. We focus on the (1e,1h) charge configuration with a single excess electron of the conduction band confined in the n-type dot and a single missing electron in the valence band state of the p-type dot for which lifting of the Pauli blockade of the current was observed in the electric-dipole spin resonance (Laird et al 2013 Nat. Nanotechnol. 8 565). The dynamics of the system driven by periodic electric field is studied with the Floquet theory and the time-dependent configuration interaction method with the single-electron spin-valley-orbitals determined for atomistic tight-binding Hamiltonian. We find that the transitions lifting the Pauli blockade are strongly influenced by coupling to a vacuum state with an empty n dot and a fully filled p dot. The coupling shifts the transition energies and strongly modifies the effective g factors for axial magnetic field. The coupling is modulated by the bias between the dots but it appears effective for surprisingly large energy splitting between the (1e,1h) ground state and the vacuum (0e, 0h) state. Multiphoton transitions and high harmonic generation effects are also discussed.

Effect of composition and coating on the interparticle interactions and magnetic hardness of MFe2O4 (M = Fe, Co, Zn) nanoparticles.

Single domain superparamagnetic ferrite nanoparticles with the composition MFe2O4 (M = Fe, Co, Zn) have been prepared by thermal decomposition of metal acetylacetonates in diphenyl ether or dibenzyl ether, using oleic acid in the presence of oleylamine as a stabilizing agent. The Fe, Co and Zn ferrite nanoparticles are monodisperse with diameters of 4.9, 4.4 and 4.7 nm, respectively. The TG and IR results indicate that four or six carboxylate groups per nm2 are bonded at the surface of the particles acting as chelating and/or bridging bidentate ligands depending on the composition. The oleate groups minimize the interparticle interactions in Fe and Zn ferrite samples, while in the Co ferrite sample dipolar interactions produce broad maxima in the ZFC and energy barriers distribution curves. The inversion degree has been estimated from the Raman spectra and the obtained x values have been used to calculate the saturation magnetization and compare them with the experimental MS values. Compared to bulk materials, the magnetization value is higher for the Zn ferrite sample due to its mixed spinel cation distribution. For the Co ferrite sample, and probably for the Fe one, the low value of saturation magnetization seems to be due to the surface disordered layer of canted spins. Compared to non-coated nanoparticles with the same composition and similar size, the oleate groups, covalently bonded to the superficial cations, increase the anisotropy field and decrease the magnetization.

Attosecond physics at the nanoscale.

Recently two emerging areas of research, attosecond and nanoscale physics, have started to come together. Attosecond physics deals with phenomena occurring when ultrashort laser pulses, with duration on the femto- and sub-femtosecond time scales, interact with atoms, molecules or solids. The laser-induced electron dynamics occurs natively on a timescale down to a few hundred or even tens of attoseconds (1 attosecond = 1 as = 10-18 s), which is comparable with the optical field. For comparison, the revolution of an electron on a 1s orbital of a hydrogen atom is ∼152 as. On the other hand, the second branch involves the manipulation and engineering of mesoscopic systems, such as solids, metals and dielectrics, with nanometric precision. Although nano-engineering is a vast and well-established research field on its own, the merger with intense laser physics is relatively recent. In this report on progress we present a comprehensive experimental and theoretical overview of physics that takes place when short and intense laser pulses interact with nanosystems, such as metallic and dielectric nanostructures. In particular we elucidate how the spatially inhomogeneous laser induced fields at a nanometer scale modify the laser-driven electron dynamics. Consequently, this has important impact on pivotal processes such as above-threshold ionization and high-order harmonic generation. The deep understanding of the coupled dynamics between these spatially inhomogeneous fields and matter configures a promising way to new avenues of research and applications. Thanks to the maturity that attosecond physics has reached, together with the tremendous advance in material engineering and manipulation techniques, the age of atto-nanophysics has begun, but it is in the initial stage. We present thus some of the open questions, challenges and prospects for experimental confirmation of theoretical predictions, as well as experiments aimed at characterizing the induced fields and the unique electron dynamics initiated by them with high temporal and spatial resolution.

Magnetic molecularly imprinted polymer for the isolation and detection of biotin and biotinylated biomolecules.

Magnetic separation based on biologically-modified magnetic particles is a preconcentration procedure commonly integrated in magneto actuated platforms for the detection of a huge range of targets. However, the main drawback of this material is the low stability and high cost. In this work, a novel hybrid molecularly-imprinted polymer with magnetic properties is presented with affinity towards biotin and biotinylated biomolecules. During the synthesis of the magneto core-shell particles, biotin was used as a template. The characterization of this material by microscopy techniques including SEM, TEM and confocal microscopy is presented. The application of the magnetic-MIPs for the detection of biotin and biotinylated DNA in magneto-actuated platforms is also described for the first time. The magnetic-MIP showed a significant immobilization capacity of biotinylated molecules, giving rise to a cheaper and a robust method (it is not required to be stored at 4°C) with high binding capacity for the separation and purification under magnetic actuation of a wide range of biotinylated molecules, and their downstream application including determination of their specific targets.

Manejo anestésico para la atresia de vías biliares (procedimiento de Kasai) / Anesthetic management for biliary atresia (procedure Kasai)

No disponible

Vía aérea difícil por tumor amigdalar y osteofito vertebral anterior / Difficult airway by tonsillar and anterior vertebral osteophyte tumor

No disponible

Neumotórax iatrogénico secundario a inserción de sonda nasogástrica / Iatrogenic pneumothorax secondary to the insertion of a nasogastric tube

No disponible

Risk of ischemic stroke associated with non-steroidal anti-inflammatory drugs and paracetamol: a population-based case-control study.

OBJECTIVE: To assess the risk of non-fatal ischemic stroke associated with non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. The effects of dose, duration of treatment, background cardiovascular (CV) risk and use of concomitant aspirin were studied. METHODS: We performed a population-based case-control study. Patients were considered exposed if they were on treatment within a 30-day window before the index date. We estimated adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) using logistic regression. RESULTS: Two thousand eight hundred and eighty-eight cases and 20 000 controls were included. No increased risk was observed with traditional NSAIDs as a group (OR = 1.03; 95% CI, 0.90-1.19), but results varied across individual agents and conditions of use. An increased risk was found with diclofenac (OR = 1.53; 95% CI, 1.19-1.97), in particular when used at high doses (OR = 1.62; 1.06-2.46), over long-term periods (> 365 days; OR = 2.39; 1.52-3.76) and in patients with a high background CV risk (OR = 1.78; 1.23-2.58), as well as with aceclofenac when used at high doses (OR = 1.67; 1.05-2.67), in long-term treatments (OR = 2.00; 1.14-3.53) and in patients with CV risk factors (OR = 2.33; 1.40-3.87). No association was found with ibuprofen (OR = 0.94; 0.76-1.17) or naproxen (OR = 0.68; 0.36-1.29). The concomitant use of aspirin did not show a significant effect modification. Paracetamol did not increase the risk overall (OR = 0.97; 0.85-1.10) or in patients at high CV risk (OR = 0.94; 0.78-1.14). CONCLUSIONS: Diclofenac and aceclofenac increase the risk of ischemic stroke while ibuprofen and naproxen do not. Dose, duration and baseline CV risk, but not aspirin use, appear to modulate the risk. Paracetamol does not increase the risk, even in patients with a high background CV risk.